GP services

Summarising the effects of staffing retention issues and the shortfall in funding and investment in GP services.

Key figures

  • 1,910 – Fewer fully qualified, permanent GPs in general practice in September 2023 compared to September 2015 – a 6.7% decline.
  • 10.5% – The proportion of the under-40 GP workforce that left the service in the 12 months to March 2023 – a record high.
  • 162.3m – Appointments delivered by GPs in 2022/23 – a 5.3% increase on 2019/20.
  • 12.5m – Referrals made by GPs in 2022/23 – a 4.5% increase from 2021/22, but still below the 13.2m made in 2019/20.
  • 31,370 – More direct patient-care staff in June 2023 than in March 2019 – exceeding the government’s target of 26,000.

Staff retention

The number of fully qualified GPs in England has declined by 7% over the last seven years. The government has tried to solve its retention and capacity issue by recruiting greater numbers of trainees, but this has not translated into an equivalent increase in fully qualified, permanent GPs.

High workloads are adding to the stress of the job for GPs and are likely contributing to growing numbers leaving general practice. Retention issues are particularly acute among younger GPs, with record numbers of GPs aged under 40 leaving the service in the 12 months to March 2023. The result is that there are fewer GPs aged under 40 than at any other point on record. Resolving the crisis in the GP workforce should remain the government’s top priority for the service.


Despite this decline in numbers, general practice is delivering more appointments than ever. GPs delivered 8% more appointments in 2023 than in 2019, while the recruitment of an extra 26,000 direct care staff contributed to a 6% increase in appointments with non-GP staff. However, there is still not enough capacity to meet demand, with the patient-to-GP ratio across England standing at 2,340 in March 2023. The ‘safe’ level is 1,800. Patient satisfaction also dropped to its lowest level on record at 71% compared to 83% in 2019, with patients struggling to access appointments.

Funding and investment

Improving GP access will require investment, and part of that needs to be in the workforce. With one in four GPs reporting that they are treating patients in premises that aren’t fit for purpose, the estate is not adequate for a large expansion of the workforce. Until the government solves these issues, it is unlikely that the supply of primary care will keep pace with demand.

The government published its delivery plan for recovering access to primary care in May 2023. It is still too early to tell if that plan will have the desired effect, but it at least recognises some of the service’s problems, such as historic underinvestment in capital, with its proposal to upgrade practices’ telephony systems.

The government is not taking a similar approach to all elements of general practice funding. With the exception of its decision to fund the recent uplift in salaried GPs’ pay by reallocating funding from elsewhere in the NHS, the government has remained steadfast in sticking to the funding levels agreed in 2019, despite recent inflation being far higher than predictions at the time. As a result, the BMA’s GPC threatened to ballot on industrial relations, but has since backed down in anticipation of a new contract in 2024/25.